<link href="//netdna.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//netdna.bootstrapcdn.com/bootstrap/3.2.0/js/bootstrap.min.js"></script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"></script>
<form class="form-horizontal">
<fieldset>
<legend>CRM PRIMME</legend>
<div class="control-group">
<label class="control-label" for="textinput">Data</label>
<div class="controls">
<input id="textinput" name="textinput" type="text" placeholder="01/01/0101" class="input-small">
</div>
</div>
<div class="control-group">
<label class="control-label" for="selectbasic">Empresa</label>
<div class="controls">
<select id="selectbasic" name="selectbasic" class="input-medium">
<option>Empresa 01</option>
<option>Empresa 03</option>
</select>
</div>
</div>
<div class="control-group">
<label class="control-label" for="textinput">Usuario</label>
<div class="controls">
<input id="textinput" name="textinput" type="text" placeholder="AAAAAAAAA" class="input-small">